Thursday, July 16, 2009

Do I Bring Bad Luck?

The Ortho department has two different types of surgeries - the emergency ones, and the elective ones.

Emergency OT is open 24 hours a day and as the name implies, caters for all emergency surgeries (surgeries that have to be done fast to prevent complications) like open fractures, laceration wounds, diabetic foot ulcers, compartment syndrome, etc.

The elective OT does all internal fixations - e.g. plating, screw fixation.

We have 2 elective OTs - short OT (8am-3pm) and long OT (8am-9pm). Both the OTs will consist of a specialist, an MO and a HO (and of course a scrub nurse).

I have had my fair share of elective OTs.
One of the surgeries done in elective OTs is the interlocking nail (ILN), usually for fractures of the femur or tibia.


This is an X-ray post-ILN of the femur


It is a relatively simple surgery (I have heard rumors that a specialist has the record of completing the surgery in just 20 minutes!).

I have assisted in a few ILNs.
Each time, there will be some problem which will delay the surgery - sometimes causing the surgery to take up to 2 hours to complete!!

One of the surgeries - we found out intra-op that the patient also had a patella fracture.
So, we had to do tension band wiring for the patella.

Another time, the 'jig' got stuck and it took us forever to come up with a way to get it out. The patient's bone was SO strong, my MO was suffering throughout the surgery.

Once, the patient's bone was SO osteoporotic, the guide wire kept puncturing out from the bone instead of going in the bone.

There was one time when the fracture couldn't be reduced properly with the traction. We tried adding on traction, releasing traction, and abducting the leg.
I forgot what worked, but it was after a long, long time that we managed to get the fracture reduced.

And just the other day, while trying to fix the nail with a screw, the screw somehow got lost inside the patient. My MO spent quite a lot of time trying to locate the screw and take it out.

What's with me and ILNs?
Why can't I have one simple ILN that finishes in less than an hour?
:(

Today I learnt that for multiple myeloma, the following investigations need to be done (if I remember correctly).
-skeletal survey
-plasmaphoresis
-24 hour urine for Bence Jones protein
-ESR

1 comment:

vy said...

i think they check for urine & serum paraprotein as well..if i rmb it correctly la..